HEAD AND NECKHEAD AND NECK

REGIONAL LYMPHATICSREGIONAL LYMPHATICS

BONES OF FACE AND BONES OF FACE AND CRANIUMCRANIUM

• SKULLSKULL– Rigid bony boxRigid bony box– Protects brain Protects brain

and special and special sense organssense organs

– Includes bones Includes bones of the cranium of the cranium and the faceand the face

CRANIAL BONESCRANIAL BONES (Cranium = Bone Case) (Cranium = Bone Case)

• FRONTAL-Forms the forehead and roofs of FRONTAL-Forms the forehead and roofs of orbitorbit

• PARIETAL-Two form the sides and roof of PARIETAL-Two form the sides and roof of cranial cavitycranial cavity

• TEMPORAL- Two form the inferior lateral TEMPORAL- Two form the inferior lateral aspects of cranium; has mastoid process aspects of cranium; has mastoid process posterior to external auditory canalposterior to external auditory canal

• OCCIPITAL- Forms the posterior part and OCCIPITAL- Forms the posterior part and most of basemost of base

SUTURESSUTURES

SUTURES- Meshed immovable joints where SUTURES- Meshed immovable joints where the adjacent cranial bones unitethe adjacent cranial bones unite

**CORONALCORONAL- Crowns the head from ear to - Crowns the head from ear to ear at the junction of frontal and parietal ear at the junction of frontal and parietal

bonesbones

**SAGITALSAGITAL- Separates lengthwise between - Separates lengthwise between the parietal bonesthe parietal bones

**LAMBDOIDLAMBDOID- Separates parietal bones - Separates parietal bones crosswise from the occipital bonecrosswise from the occipital bone

FACIAL BONESFACIAL BONES

• 14 Facial Bones articulate at sutures except for 14 Facial Bones articulate at sutures except for the mandiblethe mandible– NASALNASAL-forms part of bridge of nose-forms part of bridge of nose– PAIRED MAXILLAE-PAIRED MAXILLAE- Unite to form upper jaw Unite to form upper jaw

bonebone– ZYGOMATICZYGOMATIC- Commonly called cheekbones- Commonly called cheekbones– MANDIBLEMANDIBLE- Lower jawbone; largest, strongest - Lower jawbone; largest, strongest

facial bone; only skull bone that movesfacial bone; only skull bone that moves– LACRIMALLACRIMAL- Smallest bones in face; lateral to - Smallest bones in face; lateral to

nasal bonesnasal bones

FONTANELSFONTANELS(fontenelle= little fountain)(fontenelle= little fountain)

• At birth, membrane-covered soft spots At birth, membrane-covered soft spots between cranial bonesbetween cranial bones

• These soft spots will eventually ossify-These soft spots will eventually ossify-replaced by bonereplaced by bone

• Allow for growth of the brain during the first Allow for growth of the brain during the first yearyear

• Posterior or occipital will ossify by 2 monthsPosterior or occipital will ossify by 2 months

• Anterior or frontal will ossify by 18-24 Anterior or frontal will ossify by 18-24 monthsmonths

FACIAL MUSCLESFACIAL MUSCLES

• Facial expressions are formed by the Facial expressions are formed by the facial musclesfacial muscles

• Mediated by cranial nerve VII, the Mediated by cranial nerve VII, the facial nervefacial nerve

• Facial muscle is symmetrical Facial muscle is symmetrical bilaterally, except for an occasional bilaterally, except for an occasional quirk or wry expressionquirk or wry expression

Figure 13-2 pg 273

SYMMETRICAL FACIAL SYMMETRICAL FACIAL STRUCTURESSTRUCTURES

• PALPEBRAL FISSURES- Opening PALPEBRAL FISSURES- Opening between eyelidsbetween eyelids

• NASOLABIAL FOLDS- Creases from NASOLABIAL FOLDS- Creases from nose to corner of mouthnose to corner of mouth

Figure13-3 p 273

Salivary glands and neck Salivary glands and neck vesselsvessels

•Salivary Glands and Neck VesselsSalivary Glands and Neck Vessels

SALIVARY GLANDSSALIVARY GLANDS

• Two pairs of salivary glands are Two pairs of salivary glands are accessible to examination on the faceaccessible to examination on the face– PAROTID-In the cheeks over the PAROTID-In the cheeks over the

mandible located near the ears; largest mandible located near the ears; largest and not normally palpableand not normally palpable

– SUBMANDIBULAR- Beneath the base of SUBMANDIBULAR- Beneath the base of the tonguethe tongue

– SUBLINGUAL- Lie in the floor of the SUBLINGUAL- Lie in the floor of the mouthmouth

NECK VESSELSNECK VESSELS• TEMPORAL TEMPORAL ARTERY-Lies superior to the ARTERY-Lies superior to the

temporalis muscle, and its pulsation is temporalis muscle, and its pulsation is palpable anterior to the earpalpable anterior to the ear

• CAROTID CAROTID ARTERY-Right and left arise from the ARTERY-Right and left arise from the aorta and are the principal blood supply to the aorta and are the principal blood supply to the head and neck; each of these two arteries head and neck; each of these two arteries divide to form the external and internal divide to form the external and internal carotid arteriescarotid arteries

• JUGULAR VEIN-JUGULAR VEIN- ExternalExternal-Lies superficial to the -Lies superficial to the sternocleidomastoid muscle as it passes down sternocleidomastoid muscle as it passes down the neck to join the subclavian vein; the neck to join the subclavian vein; receives receives blood from the exterior of the cranium and the blood from the exterior of the cranium and the deep parts of the facedeep parts of the face; ; INTERNALINTERNAL-Directly -Directly continuous with the transverse sinus, continuous with the transverse sinus, accompanying the internal carotid as it passes accompanying the internal carotid as it passes down the neck; down the neck; Receives blood from the brain Receives blood from the brain and superficial parts of the face and neck and superficial parts of the face and neck

.

•Salivary Glands and Neck VesselsSalivary Glands and Neck Vessels

3333

LANDMARKSLANDMARKS

• Vertebra Prominens-C7 vertebra; has Vertebra Prominens-C7 vertebra; has a long spinous process that can be a long spinous process that can be felt when the neck is flexedfelt when the neck is flexed

• Temporal Artery-Pulsation is palpable Temporal Artery-Pulsation is palpable anterior to earanterior to ear

Figure 13-4. p 274.

MUSCLES OF THE NECKMUSCLES OF THE NECK

•Muscles of the NeckMuscles of the Neck

NECK MUSCLESNECK MUSCLES

• STERNOMASTOIDSTERNOMASTOID- Arises from the sternum - Arises from the sternum and the medial part of the clavicle and and the medial part of the clavicle and extends diagonally across the neck to the extends diagonally across the neck to the mastoid process behind the ear; mastoid process behind the ear; Accomplishes Accomplishes head rotation and flexionhead rotation and flexion

• TRAPEZIUSTRAPEZIUS- Two muscles that form a - Two muscles that form a trapezoid shape on the upper back arising trapezoid shape on the upper back arising from the occipital bone and extends fanning from the occipital bone and extends fanning out to the clavicle and scapula; out to the clavicle and scapula; moves the moves the shoulders and extends and turns the headshoulders and extends and turns the head

TRIANGLESTRIANGLES

• The sternomastoid muscleThe sternomastoid muscle divides each divides each side of the neck into two triangles:side of the neck into two triangles:– Anterior triangleAnterior triangle -Formed by -Formed by medial borders medial borders

of sternocleidomastoid muscle and of sternocleidomastoid muscle and mandiblemandible; Inside has hyoid, cricoids ; Inside has hyoid, cricoids cartilage, trachea, thyroid, anterior cervical cartilage, trachea, thyroid, anterior cervical lymph nodeslymph nodes

– Posterior trianglePosterior triangle - - Formed by trapezius, Formed by trapezius, sternocleidomastoid muscles and claviclesternocleidomastoid muscles and clavicle; ; contains posterior cervical lymph nodescontains posterior cervical lymph nodes

THYROID GLANDTHYROID GLAND

• Important endocrine gland with a rich blood Important endocrine gland with a rich blood supplysupply

• Straddles the trachea in the middle of neckStraddles the trachea in the middle of neck• Synthesizes and secretes thyroxine (T4) Synthesizes and secretes thyroxine (T4)

and triiodothyronine (T3), hormones that and triiodothyronine (T3), hormones that stimulate the rate of cellular metabolismstimulate the rate of cellular metabolism

• Has 2 lobes, conical in shape connected in Has 2 lobes, conical in shape connected in the middle by a thin isthmus lying over the the middle by a thin isthmus lying over the 22ndnd and 3 and 3rdrd tracheal rings tracheal rings

• Sometimes a 3Sometimes a 3rdrd lobe (pyramidal) is present lobe (pyramidal) is present and is cone shapedand is cone shaped

NeckNeck• CRICOIDCRICOID- Above the thyroid isthmus - Above the thyroid isthmus

within about 1cm is the cricoid within about 1cm is the cricoid cartilage or upper tracheal ringcartilage or upper tracheal ring

• THYROID CARTILAGE-THYROID CARTILAGE- Above the Above the cricoid with a small palpable notch in cricoid with a small palpable notch in its upper edge-the Adam’s Apple-its upper edge-the Adam’s Apple-forms anterior wall of larynxforms anterior wall of larynx

• HYOIDHYOID- Highest is the hyoid bone, - Highest is the hyoid bone, palpated at the level of the floor of palpated at the level of the floor of the mouththe mouth

Figure 13-5 p. 274.

•Location of Thyroid GlandLocation of Thyroid Gland

LYMPH NODESLYMPH NODES

Major part of immune system detecting and Major part of immune system detecting and eliminating foreign substances from the bodyeliminating foreign substances from the body

Oval structures located along the length of Oval structures located along the length of lymphatic vesselslymphatic vessels

Scattered throughout the bodyScattered throughout the bodyPacked with lymphocytesPacked with lymphocytesLymph (clear, watery fluid) flows in one direction Lymph (clear, watery fluid) flows in one direction

thru nodethru nodeFilters lymph of foreign substances as passes Filters lymph of foreign substances as passes

back into bloodstreamback into bloodstreamForeign substances are trapped by reticular Foreign substances are trapped by reticular

fibers and destroyed by phagocytosis and fibers and destroyed by phagocytosis and lymphocyteslymphocytes

Figure 13-6 p. 275.

•Location of Lymph NodesLocation of Lymph Nodes

Figure 13-7. p. 276

DRAINAGE PATTERNS OF DRAINAGE PATTERNS OF LYMPH NODESLYMPH NODES

•Order of Palpation of Lymph NodesOrder of Palpation of Lymph Nodes

Accessible Lymph Nodes to Accessible Lymph Nodes to LocateLocate

• SubmentalSubmental

• Sub mandibularSub mandibular

• SupraclavicularSupraclavicular

• Superficial Anterior CervicalSuperficial Anterior Cervical

• Preauricular and PostauricularPreauricular and Postauricular

• OccipitalOccipital

• Superficial Posterior CervicalSuperficial Posterior Cervical

Subjective DataSubjective Data

• Headache-unusually frequent or Headache-unusually frequent or severe, onset-gradual or sudden, severe, onset-gradual or sudden, locaton, character, course or duration, locaton, character, course or duration, precipitating factors, associated precipitating factors, associated factors, aggravating/alleviating factors, factors, aggravating/alleviating factors, meds?, other illnesses?, pattern, effort meds?, other illnesses?, pattern, effort to treat; migraines, tension, clusterto treat; migraines, tension, cluster

• HEAD Injury-Loss of consciousness or HEAD Injury-Loss of consciousness or change in level of consciousnesschange in level of consciousness

SUBJECTIVE DATASUBJECTIVE DATA

• Dizziness -lightheaded feeling vs. Dizziness -lightheaded feeling vs. vertigo which is rotational spinningvertigo which is rotational spinning

• Neck Pain -Limitations to range of Neck Pain -Limitations to range of motionmotion

• Lumps or Swelling-tenderness Lumps or Swelling-tenderness indicates infection while persistent indicates infection while persistent lump arouses malignancy suspicionlump arouses malignancy suspicion

• Hx of head or neck surgeryHx of head or neck surgery

Objective DataObjective Data

• Normocephalic-round symmetrical Normocephalic-round symmetrical skullskull

• Microcephalic-abnormally small headMicrocephalic-abnormally small head

• Macrocephalic-abnormally large headMacrocephalic-abnormally large head

• Hydrocephalic-obstruction of Hydrocephalic-obstruction of drainage of cerebrospinal fluid in the drainage of cerebrospinal fluid in the head resulting in enlargementhead resulting in enlargement

Abnormal Facial FeaturesAbnormal Facial Features

• TICS- Abnormal facial movementsTICS- Abnormal facial movements

• Exophthalmos- bulging eyeballsExophthalmos- bulging eyeballs

• Acromegaly- Gradual enlargement of Acromegaly- Gradual enlargement of the bones of the face and jawsthe bones of the face and jaws

INFANT HEAD FINDINGSINFANT HEAD FINDINGS

• MOLDING- Bones overlap due to MOLDING- Bones overlap due to passing through the birth canalpassing through the birth canal

• CEPHALHEMATOMA- collection of CEPHALHEMATOMA- collection of blood under the scalp due to traumablood under the scalp due to trauma

• DEPRESSED FONTANELS- Due to DEPRESSED FONTANELS- Due to dehydrationdehydration

• BULGING FONTANELS- May indicate BULGING FONTANELS- May indicate increase in intracranial pressureincrease in intracranial pressure

Palpating Lymph NodesPalpating Lymph Nodes

• USE A FIRM DELIBERATE YET USE A FIRM DELIBERATE YET GENTLE GENTLE TOUCHTOUCH

• INFECTIONINFECTION-- May be indicated when May be indicated when nodes are palpable bilaterally, feel nodes are palpable bilaterally, feel large, warm, tender, firm but freely large, warm, tender, firm but freely movablemovable

• MALIGNANCYMALIGNANCY- May be indicated when - May be indicated when nodes are unilateral, hard, discrete, nodes are unilateral, hard, discrete, asymmetric, fixed, and nontenderasymmetric, fixed, and nontender

• Abnormal Nodes- Explore the area Abnormal Nodes- Explore the area proximal (upstream) to the location of proximal (upstream) to the location of the abnormal nodethe abnormal node

Palpate Deep Cervical ChainPalpate Deep Cervical Chain

Palpate supraclavicular Palpate supraclavicular nodenode

Palpate cervical nodesPalpate cervical nodes

Palpate TracheaPalpate Trachea

.

Palpate Thyroid; PosteriorPalpate Thyroid; Posterior appraochappraoch

Palpate Thyroid: Anterior Palpate Thyroid: Anterior appraochappraoch

HEAD & NECKHEAD & NECK

• Skull palpationSkull palpation

• Face/jawFace/jaw

• Head PositionHead Position

• Neck ROM and strengthNeck ROM and strength

• TracheaTrachea

• Cricoid cartilageCricoid cartilage

• Thyroid cartilage Thyroid cartilage

• ThyroidThyroid